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Autistic spectrum disorders (ASDs)

Published by Bupa's health information team, August 2007.

This factsheet is for people who would like information about autism and other autistic spectrum disorders.

Children with an autistic spectrum disorder (ASD) don't develop the social and language skills that other children do. As a result of this, they find relating to other people difficult. They may also have unusual behaviours and learning difficulties.

What is the autistic spectrum?

Autism is a range, or spectrum, of disorders that affect individuals to varying degrees. A child can have their own combination of difficulties, putting them somewhere on what is called the autistic spectrum. Some children with autism may have learning difficulties and very limited speech and communication. Other children with a milder form of autism, called Asperger's syndrome, may have a good vocabulary but still have difficulty with communication.

According to the National Austistic Society, over 500,000 people in the UK have an ASD. A study published in 2006 has shown that as many as one in 100 children may have an ASD. It's four times more common in boys than girls.

Symptoms

Children with an ASD have three main types of problems. These are to do with their:

  • communication
  • social development
  • interests and behaviour (social imagination)

If you notice signs of ASD in your child, you should see your health visitor or GP.

Communication

Children with ASDs may not develop the usual speech or non-verbal (eg pointing) skills of other children of the same age. They may also have trouble with understanding meaning in spoken or written language. Children with severe autism may never speak at all but may be helped to communicate in other ways (eg signing or using picture symbols).

These communication problems may show up as:

  • not babbling or pointing by the age of one
  • not responding to their name
  • not learning two words by the age of two
  • in older children, unusual use of language and difficulty starting or keeping up conversations
  • repeating words they have heard over and over again

Social development

Children with an ASD may have difficulty in making friends and getting on well with their peers. They may:

  • seem very independent as toddlers and aloof when they get older
  • have poor eye contact
  • not seek affection in the usual way and resist being cuddled or kissed
  • be unable to play with other children and have difficulty making friends
  • seem to be "in a world of their own"
  • not understand other people's thoughts and emotions
  • find it difficult to accept simple social rules, which can cause problems at school

Children with an ASD can be affectionate, but may not be able to respond to another person's need for affection.

Behaviour and interests

Children with an ASD may show very little or no interest in play that involves pretending. Instead they may be overly interested in repetitive activities, such as lining up their toys or watching the washing machine drum rotate. Children with an ASD may also:

  • learn to sit up or walk later than most children
  • be oversensitive to noise or to touch (for instance, finding the vacuum cleaner or hairdryer deafening)
  • have odd mannerisms such as rocking back and forth, hand flapping, walking on tip toes or head banging
  • some may be clumsy and so struggle with physical activity

Older children and adolescents may develop obsessions such as an excessive interest in timetables or lists, and in storing up trivial facts.

Intelligence and autism

Around three-quarters of people with an ASD have a learning disability. Some people who have Asperger's syndrome may have normal or high intelligence but struggle with social skills. Outstanding abilities with maths, music or drawing are uncommon.

Causes

Experts think ASDs are caused by differences in the way the brain develops before, during or soon after birth. It is also though that the genes a child inherits from their parents have an important role in determining whether they will have autism. However, the exact cause is unknown and it's probably due to a combination of different factors. There is a lot of ongoing research looking into the causes of ASD.

Autism and MMR

There have been media reports about a possible link between autism and the MMR (measles, mumps and rubella) vaccine. However, this is an unproven link and there is no scientific evidence to support it. There is plenty of evidence to support the safety of the MMR vaccine.

Diagnosis

Autism is usually diagnosed in childhood, when a parent raises a concern about their child with their GP or health visitor. A developmental paediatrician - a doctor specialising in child development - can usually diagnose autism in children between the ages of two and three.

A milder form of ASD, such as Asperger's syndrome, is often not noticed until the child starts school because many aspects of their development are normal. At school their poor social skills are more noticeable and they may show challenging behaviour.

There is no medical test (eg blood test or brain scan) for ASDs. However tests may be carried out to exclude other conditions (eg hearing problems). The diagnosis is then based on observing the communication, behaviour and development of the child. Professionals will involve you in the assessment to find out about your child's development.

If autism is suspected, the child may be assessed at a child development centre to identify his or her specific needs. The child may see a range of professionals including a consultant developmental paediatrician, a child psychiatrist (doctor specialising in children's mental health), speech therapist, occupational therapist, psychologist, and an educational expert such as a specialist teacher or educational psychologist.

Each child should have an appointed key worker, such as a health visitor or school nurse, who knows about the assessment process and acts as a single point of contact.

Therapies and interventions

There are no known cures for autism, but children can be helped in many ways. Interventions for ASD include special education, behavioural training, social skills training and, in some cases, medicines.

All children with an ASD need some special educational support. This may be in a special school, or depending on the child's needs, he or she may go to a mainstream school with extra individual help. In general, autistic children do better if classroom activities are very structured.

One therapy may work for one child but not for another, as all children have different levels of needs and abilities.

Behavioural therapies

These may be provided by a clinical psychologist or trained therapist and can help a family cope with any behavioural problems associated with autism. This generally involves rewarding good behaviour with praise but having a consistent and structured way of dealing with challenging or harmful behaviour. Similar methods may be used at school where the child can be taught improved ways to express themselves.

Medicines

Sometimes medication is used to reduce specific symptoms. For example, some medicines can be used in the short term to help relieve agitation, obsessional or hyperactive behaviour. However, these can have side-effects if used for a long time. For example, drugs to reduce hyperactivity can increase repetitive and obsessional behaviour. Medication should always be used together with behavioural therapies.

Other treatments

There are various approaches available to help with communication and learning; these include the following.

  • Intensive pre-school training.
  • A type of therapy called applied behaviour analysis (eg Lovaas therapy). This is a home-based one to one therapy delivered by professionals (eg psychologists) and parents, who have been trained in the method. It involves a system of rewards for acceptable behaviours. This is an intensive therapy with 35 to 40 hours per week of structured contact with the child.
  • A system based on using picture symbols (eg Picture Exchange Communication System, or PECS for short).

Although many parents find these approaches very helpful, and many experts believe offering early therapy for a child with autism is beneficial, there is only limited formal evidence (from research studies) that they are effective. Also, they may not be available where you live.

Help and support

Parents and carers need information, help and support. This should be provided by the health professionals involved in your child's care, but further advice is available from charities such as the National Autistic Society (see Further information).

Respite breaks give you a chance to rest while somebody else looks after your child. They may be provided by social services. Some families are also entitled to benefits such as disability living allowance to help cover the extra expenses involved in caring for their child.

Further information

Related topics

Sources

  • Baird G, Cass H, Slonims V. Diagnosis of autism. Br Med J 2003; 327:488
  • Baird G, Simonoff E, Pickles A et al. Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). The Lancet 2006; 368: 210-215
  • Volkmar F, Pauls D. Autism. The Lancet 2003; 362: 1133-1141
  • Happe F, Ronald A, Plomin R. Time to give up on a single explanation for autism. Nature Neuroscience 2006; 9: 1218
  • Rapin I. Autism. New England Journal of Medicine 1997; 337: 97
  • Wilson K, et al. Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence. Archives of Pediatrics and Adolescent Medicine 2003; 157: 628-634
  • MMR vaccine: how effective and how safe? Drug and Therapeutics Bulletin 2003; 41: 25-29
  • Smeeth L, et al. MMR vaccination and pervasive developmental disorders: a case-control study. The Lancet 2004; 364: 963-369
  • Pursell E. Exploring the evidence surrounding the debate on MMR and autism. British Journal of Nursing 2004; 13: 834-838
  • National Service Framework for children, young people and maternity services: autism. Department of Health. 2004.
    www.dh.gov.uk

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr. Colin Melville, MB Ch.B MRCP, consultant paediatrician, Staffordshire General Hospital, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2007

 

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